Lutheran Downtown Hospital — price list

← Hospital overviewVerified from Lutheran Downtown Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

59 prices shown (filtered).

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
00003-2328-22 - ipilimumab Soln Inpatient	1279402-2255213 CDM	$494,190	$271,805	$140,844 – $494,190	—
00003-2328-22 - ipilimumab Soln Outpatient	1279402-2255213 CDM	$494,190	$118,606	$118,606 – $494,190	—
00310-4535-30 - tremelimumab actl 20 mg/mL Soln Inpatient	109228707-2247357 CDM	$413,990	$227,694	$117,987 – $413,990	—
00310-4535-30 - tremelimumab actl 20 mg/mL Soln Outpatient	109228707-2247357 CDM	$413,990	$99,358	$99,358 – $413,990	—
30237-8900-06 - sipuleucel-T - Susp Inpatient	51905029-2247357 CDM	$752,774	$414,026	$214,541 – $752,774	—
30237-8900-06 - sipuleucel-T - Susp Outpatient	51905029-2247357 CDM	$752,774	$180,666	$180,666 – $752,774	—
4060018 OTH STER SUPP LVL 18[Omnicell Cath Lab] Inpatient	100133675-2114382 CDM	$269,188	$148,053	$76,719 – $269,188	—
4060018 OTH STER SUPP LVL 18[Omnicell Cath Lab] Outpatient	100133675-2114382 CDM	$269,188	$64,605	$64,605 – $269,188	—
4070018 OTH STER SUPP LVL 18[Omnicell EP Lab] Inpatient	103179668-2114382 CDM	$269,188	$148,053	$76,719 – $269,188	—
4070018 OTH STER SUPP LVL 18[Omnicell EP Lab] Outpatient	103179668-2114382 CDM	$269,188	$64,605	$64,605 – $269,188	—
54482-0301-01 - pegaspargase 3750. Soln Inpatient	1282362-2255213 CDM	$370,304	$203,667	$105,537 – $370,304	—
54482-0301-01 - pegaspargase 3750. Soln Outpatient	1282362-2255213 CDM	$370,304	$88,873	$88,873 – $370,304	—
57665-0002-02 - pegaspargase 3750. Soln Inpatient	1282361-2255213 CDM	$370,304	$203,667	$105,537 – $370,304	—
57665-0002-02 - pegaspargase 3750. Soln Outpatient	1282361-2255213 CDM	$370,304	$88,873	$88,873 – $370,304	—
57894-0061-03 - ustekinumab 90 mg/mL Soln Inpatient	94990000-2255213 CDM	$358,159	$196,987	$102,075 – $358,159	—
57894-0061-03 - ustekinumab 90 mg/mL Soln Outpatient	94990000-2255213 CDM	$358,159	$85,958	$85,958 – $358,159	—
60809-0801-01 - pegloticase 8 mg/mL Soln Inpatient	95367892-2255213 CDM	$404,861	$222,673	$115,385 – $404,861	—
60809-0801-01 - pegloticase 8 mg/mL Soln Outpatient	95367892-2255213 CDM	$404,861	$97,167	$97,167 – $404,861	—
67979-0002-01 - histrelin 50 mg Implan Inpatient	108087544-2247355 CDM	$431,276	$237,202	$122,914 – $431,276	—
67979-0002-01 - histrelin 50 mg Implan Outpatient	108087544-2247355 CDM	$431,276	$103,506	$103,506 – $431,276	—
69866-1025-01 - autologous cultured chondrocytes 0 Inpatient	108963946-2247355 CDM	$415,834	$228,708	$118,513 – $415,834	—
69866-1025-01 - autologous cultured chondrocytes 0 Outpatient	108963946-2247355 CDM	$415,834	$99,800	$17,112 – $415,834	—
69866-1030-05 - autologous cultured chondrocytes i Inpatient	108963947-2247355 CDM	$415,834	$228,708	$118,513 – $415,834	—
69866-1030-05 - autologous cultured chondrocytes i Outpatient	108963947-2247355 CDM	$415,834	$99,800	$99,800 – $415,834	—
69866-1030-08 - autologous cultured chondrocytes 1 Inpatient	108978003-2247355 CDM	$415,834	$228,708	$118,513 – $415,834	—
69866-1030-08 - autologous cultured chondrocytes 1 Outpatient	108978003-2247355 CDM	$415,834	$99,800	$99,800 – $415,834	—
71336-1001-01 - givosiran 189 mg/mL Soln Inpatient	108329173-2255213 CDM	$565,500	$311,025	$161,168 – $565,500	—
71336-1001-01 - givosiran 189 mg/mL Soln Outpatient	108329173-2255213 CDM	$565,500	$135,720	$135,720 – $565,500	—
72187-0401-01 - tagraxofusp 1000 mcg/mL Soln Inpatient	108290516-2247357 CDM	$328,602	$180,731	$93,652 – $328,602	—
72187-0401-01 - tagraxofusp 1000 mcg/mL Soln Outpatient	108290516-2247357 CDM	$328,602	$78,864	$78,864 – $328,602	—